This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
Sexual assault referral centres (SARCs) offer survivors of sexual violence medical care, emotional support, and forensic services. They refer survivors to independent sexual violence advisors and other services. A review of 21 of the centres in England found that people who accessed them:
- were positive about the support they received
- reported improvements in symptoms of post-traumatic stress disorder (PTSD) after 1 year
- often experienced delays in accessing follow-on mental healthcare.
Based on their findings, the researchers made suggestions about how to improve services.
Help after rape and sexual assault can be found on the NHS website.
How effective are sexual assault referral centres?
Sexual violence violates human rights and is a serious threat to a person’s health and wellbeing across their life. In England and Wales, more than a million adults are sexually assaulted each year; 15% of girls and 5% of boys are sexually assaulted by the age of 16.
Without specialist support, the consequences of sexual violence can get worse over time, damaging survivors’ mental and physical health, and impacting their social and economic wellbeing. Poor responses from clinicians, criminal justice agencies and wider society can increase survivors’ isolation and contribute to the long-term harms they experience.
Sexual assault referral centres are often the first point of care for adults, young people and children subjected to abuse. There are over 50 centres across England and around 30,000 survivors access them each year. They provide survivors with crisis support, care for medical needs and sexual health, and the choice to have a forensic medical examination to collect evidence. They support people who wish to report the abuse to the police.
In a mixed methods study, researchers explored users’ experiences of sexual assault referral centres, and evaluated the care pathways they followed afterwards. These included NHS, social care and voluntary sector services, independent sexual violence advisors (who advocate for survivors through the criminal justice process), police and criminal justice services.
What’s new?
The researchers analysed data on 335 survivors who accessed 21 sexual assault referral centres across England. Their average age was 32 years, most were women (90%) and white (85%).
Survivors went on to access a range of services. These were mostly voluntary organisations (such as Rape Crisis and mental health charities) followed by independent sexual violence advisors, the police and criminal justice agencies, and the NHS (mainly GPs, mental health and sexual health services).
Participants rated their experience of different services; they were mostly positive about sexual assault referral centres and the voluntary sector (few interactions, 1% and 4% respectively, were experienced as harmful). Feedback was mixed about wider NHS services (including general practice and sexual health clinics, for example, but not SARCs) and the police and criminal justice service (15% and 25% of interactions, respectively, were experienced as harmful).
On entry to the study (100 days on average after accessing sexual assault referral centres), most survivors (71%) had probable PTSD. This proportion was reduced 1 year later (but remained high, at 55%). PTSD was highest among people with adverse childhood experiences, those with poor mental health before the sexual assault, and economic difficulties.
People who use sexual assault referral centres differ from survivors in the general population, the authors note. Many participants (44%) accessed the sexual assault referral centre within 10 days of the sexual trauma and many (38%) had a forensic medical examination; most (77%) had 4 or more adverse childhood experiences.
The researchers interviewed 42 people from marginalised groups, such as those from ethnic minority groups, with insecure housing, or disabilities. Survivors found counselling effective but difficult to access because of long waiting lists and restrictions on the number of sessions they could have. Some saw mental healthcare as inappropriate and lacking in flexible options for those with complex trauma (for example, symptoms of PTSD coupled with problems managing emotions and relationships).
Why is this important?
This analysis provides evidence of good practice at sexual assault referral centres in England. They initiate pathways of care for many people after sexual assault, involve multiple agencies and promote access to justice. They may therefore minimise the long-term social, emotional and physical harms of abuse.
Sexual assault referral centres offer excellent care, the researchers say, but are underused, partly due to a lack of awareness among the public. Police forces signpost people to the service, but other areas (including primary care) lack awareness.
People with adverse childhood experiences, long-term mental health problems and economic disadvantage are particularly at risk of PTSD following sexual assault. These groups may need targeted support and access to counselling.
Researchers collected data from 2019 to 2022, and did not evaluate care that has become available more recently. In addition, the study had no comparison group and cannot conclude that access to sexual assault referral centres reduced PTSD symptoms. Findings may not be applicable to groups of people not represented in this study.
The researchers also carried out a review of 36 trials on psychological and social interventions. Among survivors of sexual violence, interventions such as cognitive behavioural therapy (CBT), eye movement desensitisation re-processing and newer treatments like trauma‐sensitive yoga led to reductions in PTSD and depression. Other work highlighted the impact of how care was provided, and the value of offering choices of therapeutic support, a positive environment and good rapport with the provider.
What’s next?
The researchers will now work with NHS England to promote uptake of their findings. They suggest that services for people who have experienced sexual violence could be improved with:
- raised awareness among the public about sexual assault referral centres
- strengthened local partnerships between the police, specialist statutory and voluntary sexual assault and abuse services and the NHS
- specialist training and support for NHS staff on trauma-informed care
- tailored support for survivors with risk factors for PTSD (such as long-term mental health issues, which were the main barrier to accessing care and justice)
- development of the role of independent sexual violence advisors to include more specialised advocacy for lesbian, gay, bisexual or trans (LGBTQI+) survivors, and those with complex needs
- greater choice of interventions within NHS mental health services.
You may be interested to read
This is a summary of: O’Doherty L, and others. Care and support by Sexual Assault Referral Centres (SARCs) in England for survivors of sexual violence and abuse: a mixed-methods study (MESARCH). Health and Social Care Delivery Research 2024; 12: 1 – 168.
Information on sexual assault referral centres including where your nearest one is.
Information and support from The Survivors Trust.
A rape and sexual abuse support line from Rape Crisis.
An NIHR Evidence summary on the effect of sexual assault on teenager’s mental health.
Funding: NIHR Health and Social Care Delivery Research Commissioned Call.
Conflicts of Interest: No relevant conflicts of interest.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
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